Digital Practice: Build a Winning Website

Focus on low-literacy patients, most popular tasks

ORLANDO -- A well-designed practice website can help both patients and physicians, but the first consideration when designing one should be ease of use, speakers said here at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).

"We redesigned a big health system website ... and one thing that tested really well is that we had these four purple buttons that had key tasks that that everybody's trying to do" -- find a physician, make an appointment, pay a bill, and open the patient portal, Sandy Hilfiker, director of user-centered design at CommunicateHealth, a website design company in Northampton, Mass., said at a session on Wednesday. "Those kind of buttons worked really, really well."

"The bottom line is that patients are key members of the healthcare team, not just recipients of information," said CommunicateHealth co-founder Stacy Robison. Currently, she said, "the health community is really designing for health systems, not just for patients. But that's starting to change and is changing -- patients are going to demand a better user experience. If you have an easy-to-use interface, that's going to be a huge differentiator."

The website should be designed so that it's accessible to people with low literacy, said Hilfiker. Although many people wonder if designing a website that way will not work for those with higher literacy skills, that doesn't turn out to be the case; Hilfiker cited a 2005 study showing that designing for low literacy improved understanding across the board.

Low-literacy users are prone to skipping content and they also "tend to focus really narrowly on the center of the screen," noted Hilfiker. "We all do this to a certain extent, but lower literacy people tend to to it more so." They also are apt to get easily overwhelmed and have limited working memory.

The speakers offered several design strategies for providers:

Identify the motivations and goals of users. "If you're doing a portal, focus on the kinds of things that are more important to patients, like communicating with the doctor, sharing notes, refilling prescriptions, and booking appointments," said Robison. "If it's more of an education website, you want to write content that answers users' questions, or helps them do a task or make a decision."

Because people are prone to skipping text, limit paragraph size and use bullets and short lists. "Does it look like it would be easy to read? A paragraph with even four sentences triggers skipping," said Hilfiker.

Avoid long sentences and too many numbers. Putting lots of numbers in a paragraph triggers skipping, Hilfiker said, so "think about how to spread [the numbers] out."

Put the more important information first, and always emphasize the behavior piece and the action steps. "Make the content actionable," said Robison.

Make the font readable; at least 16 pixels is helpful. "Use plenty of white space and avoid clutter," Hilfiker said.

Make clickable elements recognizable -- does it look like a button? Make sure it's in consistent places across the site. "The more you can make things mindless in navigation, the more that allows for people to digest and read text," said Hilfiker.

Testing the website is also extremely important, according to Hilfiker. "Ensuring that you are including people who may be more likely to have limited literacy skills is critical; that will help you make sure you're designing for all people."

Even testing with just five people will reveal 85% of usability problems. "It doesn't have to be a big deal; it doesn't have to be expensive," she added. To recruit specific groups of people, consider partnering with organizations who have the population you're trying to reach, such as senior centers or literacy groups.

If your practice doesn't have the money to hire a design firm, just get a few patients to give you some feedback, suggested Hilfiker. "What is their priority? ... Just start with that." Even if you have web pages that can't really be changed, "try to do tweaking to at least get people to the right spot."

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